How many of the following tidbits have you heard — or believed?
News for rodents
While technically not in the “fake news” category, a new (pick one) drug, procedure, treatment has been found to reverse anything when tested in mice. As a news producer once told co-author Jackie, “Great news for rodents!”It’s crucial to remember that testing in animals, while an important step in determining the effectiveness and safety of a medical treatment, is only the first step. Most of these do not make it past the first step — and remain a good option only for rodents. The scientific chain of proof before a treatment can be considered for use in humans (or even more complex mammals!) is a long one. Those in the medical community generally reserve judgment on these tidbits, which may very well stop at being rodent food for thought!
Reading about medical miracles
Everyone wants to jump on the bandwagon when it comes to reporting stories of medical miracles. Keep in mind that most (or make that all) medical journals avoid the use of the word “miracle” at all costs! Medicine and science are long and painstaking processes and rarely come across a “gimme” (or a simple, great cure) that appears out of nowhere, also known as a miracle.Actually, ASRM cautions infertility specialists against ever using the world miracle, as it is a setup for disappointment and doesn’t meet the burden of proof required. But, miraculous stories of women giving birth at (pick one) 50, 60, 70, or 80 without (considerable) assistance is the kind of story that sells. Whether a celebrity-based magazine about people (we’re not naming any names here!) or an outright tabloid, consider the source.
Celebrity fecundity (also known as fertility)
Hollywood would like us to believe that celebrities are aging without any of the ill side effects that we humans encounter including weight gain, wrinkles, and loss of fertility. Photoshop or CGI (computer-generated imagery) goes a long way in helping to sustain this myth. So, does leaving out just a “little bit” of crucial information.For example, the 55-year-old female celebrity who has “miraculously” (there’s that word again!) given birth to her first child with just a glass of wine and a prayer was more likely utilizing the best that ART has to offer, including donor eggs or egg freezing. Really, how else can celebrities maintain the pedestal that we often put them on without appearing to be better than the rest of us at defying all odds? They can’t.
Cell phones decrease male fertility
A literature search on PubMed for cell phones and male infertility turned up almost 50 articles, with some articles showing a difference and some not showing a difference. Many of the articles focused on the semen analysis but not the actual chance of achieving a pregnancy. Since the amount of time a man uses his cell phone varies considerably, there are a number of other things that may influence the semen analysis. For example, is the student, coffee-house devotee using his phone the same as the 95th-floor, high-powered executive? A representative study published in 2015 found no difference in semen results based upon cell phone usage.There was a reduced sperm count based upon internet usage with those using the internet more frequently having lower sperm counts. That raises the contentious issue of whether sitting and thus increasing testicular temperature can reduce the sperm counts.
A 2018 study looked at cell phone usage with 4G for rats. Who knew rats had cell phones? These poor little fellows were exposed to varying lengths of exposure to 4G LTE cell phones and — if that weren’t enough, egad — their testicles were assessed for number of sperm cells. The longer the exposure, the lower the number of sperm cells. Not the best study to volunteer for if you are a male rat.
But wait: Cell phones aren’t the only source of non-ionizing radiations. What about laptops, Wi-Fi, microwave ovens, and on and on. After an extensive review of the currently available research, the authors of a 2018 review concluded that non-ionizing radiation may decrease sperm parameters. They could not conclusively say this was so nor did they say the evidence conclusively demonstrated that cell phone usage causes infertility. So again — maybe!
Increased longevity means a larger fertility window
Not so much. The increased longevity (humans living longer) arises from things like antibiotics, anesthesia, pharmaceuticals, immunization, and sanitary conditions, to mention a few.The effect of these advances in the 19th and especially the 20th century increased the worldwide life expectancy of women from 54 years in1900 to 75 years in 2019. (U.S. rates are even higher at 81 years!) The average life expectancy in 1800 was between 30 and 40. So the increase in life expectancy derived from something that could be corrected. For example, women becoming infected after childbirth died at an alarming rate until antibiotics were developed that cured the infection.
In 1900, for every 1,000 births, seven women died and 40 percent were due to infections. By 1997, the maternal mortality decreased to less than 0.1 per 1,000 deliveries. But nothing has changed the underlying problem with age-related infertility. No medication has been developed that allows women to make eggs after she is born. No medication nor intervention has been devised that prevents the ovary from destroying the pool of eggs.
So, while life expectancy has increased because of problems that have solutions, living longer has not translated into longer fertility potential because nothing fixes the issue of limited egg number and rapid egg usage and wastage.
Men don’t undergo menopause
Hah! The first thing to understand is that male menopause is not the same as male fertility. The debate about age and male infertility rages, but in general, males can father children well into their 70s and maybe even 80s if they are capable of ejaculating.But males experience a decline in their testosterone levels as they age. Colloquially, this is called “low T.” The symptoms include fatigue, depression, sexual dysfunction, weakness, and loss of muscle mass, just to name a few of the symptoms.
Not all doctors agree that low T, as male menopause, actually exists, but if you ask men, they will tell you that it does. Measuring the testosterone levels may define a cause of male menopause. For men symptomatic with low T, testosterone replacement may be a solution.
Looking good means your fertility is good
Just because you can pass for 30 something, be aware that your ovaries have a mind of their own! So, you look great, feel well, eat healthy, and exercise often — congratulations! These are all excellent lifestyle choices that can help you maintain good health, to some degree, in the short and long term. They can certainly give you a great base for gestating a child and raising one with healthy habits. But, if you are 40 something, your ovaries are not in on the secret. Your ovaries will always reflect your biologic age no matter how good you look and feel.You can glue your embryos to your uterus
While this may appear to be the peak of fake news, hold on, maybe you can, sometimes. Have we confused you yet?In 2012 a study was published that found no increased pregnancy rate when embryo glue was used. A Cochrane database report in 2014 said it might improve pregnancy rate. So, where do we stand? First of all, is embryo glue actually glue? Is it like that white pasty glue we (well, apparently not coauthor Lisa) ate when we were in the third and fourth grade? Mmmmm, delicious! No! Embryo glue is not glue at all.
Embryo glue is a solution that contains hyaluronic acid. Hyaluronic acid is a naturally occurring substance in the secretions in the female reproductive tract. It tends to make things sticky. So dipping an embryo into the solution may make the embryo sticky and thus help with implantation.
A study published in 2018 used a solution of hyaluronic acid–enhanced media for frozen embryo transfers. They found that for the first transfer, the pregnancy rate was less than when not using the solution. When the patient had a second frozen embryo transfer and the solution was used, there was no difference seen. If the patient returned for a third frozen embryo transfer, then the use of the solution did improve the pregnancy rate. If a person has had two normal appearing embryos transferred and has no evidence that they implanted, she may have recurrent implantation failure (RIF). Some physicians have suggested that for this group of patients (those with RIF), the embryo glue may help.
Procreation vacations work
Vacations are great, but do they increase the chance for a pregnancy? Sorry guys, not so much. Before you book a multi-thousand-dollar vacation hoping it will help you get pregnant, you may want to reflect on what is keeping you from getting pregnant in the first place.Males with very low counts, women with blocked tubes, women who don’t ovulate on their own, women with endometriosis, age-related infertility — these and other diagnostic categories for infertility will not be helped by going on a vacation. It’s hard to imagine how lying in the sun in Tahiti can magically unblock tubes. So why even make the suggestion?
But, does this work for those patients with unexplained infertility? The reasoning is that coping with infertility increases stress. Vacations are supposed to reduce stress, ergo, taking a vacation will help you get pregnant. There are heated debates about the importance of stress in causing infertility. There is little debate as to whether infertility causes stress. And if you don’t know the answer to this debate, you haven’t really had infertility.
Infertility causes stress! Under normal circumstances, taking a vacation can reduce stress. However, taking a vacation to improve the chance of pregnancy may actually increase the stress level — there is no credible evidence looking at this possibility.
Taking a vacation to get a vacation from fertility treatments makes more sense. Breaking the daily grind of fertility treatment can be much needed and the expense is more than worth it.
Adopt and you’ll get pregnant
Maybe, but the adoption does not increase the normal treatment independent pregnancy rate (the rate of pregnancy without treatment). There is a chance that any person who has stopped fertility treatments and does nothing will get pregnant without any further treatment.If you evaluate a large number of patients who have adopted, some of them achieved a pregnancy on their own. But the chance is the same as for those who did not adopt. An interesting study from 2018 looked at what happened five years after patients had undergone IVF. The majority did no more IVF. For those who had adopted, almost 7–8 percent had a spontaneous pregnancy.
Overall, five years after IVF over 90 percent of the patients were living with children in the family. Some were from more IVF, some from spontaneous pregnancies, some as stepparents, and some from adoption. For this study almost 10 percent had a spontaneous pregnancy after stopping IVF and having not been successful with the IVF they had done.
Various studies will have somewhat different figures, but the overall point is that most people can have children in their family — just not as easily as they had expected.
